The number of babies being readmitted to hospital in their first year has decreased by over 10% in New South Wales, according to research published in the Medical Journal of Australia.
Dr Samantha Lain, a research fellow at the Kolling Institute, University of Sydney, and her coauthors used data for all (n = 788 798) live births in NSW between January 2001 through December 2009 to determine the number of infants readmitted to hospital at least once in their first year, and any changes in maternal and infant risk factors.
Readmissions of infants dropped from 18.4 per 100 births in 2001 to 16.5 in 2009, a relative reduction of 10.5%.
They also found that the proportion of mothers over the age of 35 years increased from 18% to 24% over the study period; mothers who smoked decreased from 17% to 12%; the proportion of infants discharged in the first 2 days after birth increased from 28% to 36%; and the proportion of infants staying in hospital for 5 days or longer decreased from 33% to 23%.
The most commonly diagnosed conditions that showed a significant decrease in the rate of readmissions were upper respiratory tract infections (down 1.6% per year), intestinal infectious diseases (down 3.2% per year), and viral infections (down 3.2%).
Hospital readmissions for jaundice and feeding problems increased over the study period, by 8.1% and 3.5% respectively. The authors found two trends may influence these changes. An increase in the proportion of infants discharged from hospital in the first 2 days after birth and, an "increase in the rate of infants born late preterm (34-36 weeks) and early term (37-38 weeks)," infants who have an increased risk of admission to hospital for jaundice and feeding difficulties.
"Over half of the total decrease [in hospital readmissions] can be explained by changes in the frequency of maternal and infant risk factors, predominantly a decrease in the length of stay at birth, an increase in maternal age and a decrease in maternal smoking", the authors wrote. Some of the unexplained decline in hospital readmissions may be attributable to policy changes, they wrote.
An emphasis on early antenatal visits in NSW from 2003 may have influenced the decrease in the numbers of mothers smoking during pregnancy, while the Early Postnatal Discharge program, introduced in the 1980s, and the Midwifery Support Program, which provided follow-up care post- discharge, may also have had an effect.
Changes to emergency department policy and practice in NSW may also have reduced hospital admissions, they wrote. These measures included the introduction of senior ED nurses with wider scope of practice, and after-hours GP clinics at or near EDs.
"Future research should investigate strategies for further reducing the burden on the health system of infant admissions, particularly those that may be prevented, such as strategies targeting specific groups of infants", the authors concluded.